Dutch insurance company will pay doctors to prescribe cheap drugs
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PROVIDER: S-EPMC1360423 | biostudies-literature | 2006 Feb
REPOSITORIES: biostudies-literature
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Project description:BackgroundIn a health care system based on managed competition it is important that health insurers are able to channel their enrolees to preferred care providers. However, enrolees are often very negative about financial incentives and any limitations in their choice of care provider. Therefore, a Dutch health insurance company conducted an experiment to study the effectiveness of a new method of channelling their enrolees. This method entails giving enrolees advise on which physiotherapists to choose when they call customer service. Offering this advice as an extra service is supposed to improve service quality ratings. Objective of this study is to evaluate this channelling method on effectiveness and the impact on service quality ratings.MethodsIn this experiment, one of the health insurer's customer service call teams (pilot team) began advising enrolees on their choice of physiotherapist. Three data sources were used. Firstly, all enrolees who called customer service received an online questionnaire in order to measure their evaluation of the quality of service. Enrolees who were offered advice received a slightly different questionnaire which, in addition, asked about whether they intended to follow the advice they were offered. Multilevel regression analysis was conducted to analyse the difference in service quality ratings between the pilot team and two comparable customer service teams before and after the implementation of the channelling method. Secondly, employees logged each call, registering, if they offered advice, whether the enrolee accepted it, and if so, which care provider was advised. Thirdly, data from the insurance claims were used to see if enrolees visited the recommended physiotherapist.ResultsThe results of the questionnaire show that enrolees responded favorably to being offered advice on the choice of physiotherapist. Furthermore, 45% of enrolees who received advice and then went on to visit a care provider, followed the advice. The service quality ratings were higher compared to control groups. However, it could not be determined whether this effect was entirely due to the intervention.ConclusionsChannelling enrolees towards preferred care providers by offering advice on their choice of care provider when they call customer service is successful. The effect on service quality seems positive, although a causal relationship could not be determined.
| S-EPMC6219118 | biostudies-literature
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| S-EPMC1309674 | biostudies-literature
Project description:Nausea and vomiting are common symptoms with many possible causes including the adverse effects of drugs If a drug is indicated the cause guides the choice of antiemetic drug: The main antiemetic classes include antagonists of the serotonin dopamine histamine muscarinic and neurokinin systems corticosteroids and benzodiazepines Some antiemetics appear more effective for specific indications: Serotonin and neurokinin antagonists such as ondansetron and aprepitant are highly effective in treating chemotherapy-induced nausea and vomiting Metoclopramide and antihistamines are first-line options for nausea and vomiting in pregnancy: Serotonin antagonists and some dopamine antagonists such as metoclopramide can prolong the QT interval on the ECG Dopamine antagonists can cause extrapyramidal adverse effects particularly in children:
| S-EPMC7186277 | biostudies-literature
Project description:Do stronger relationships with customers (customer-company relationships [CCR]) help firms better weather economic crises? To answer this question, we examine firm performance during the stock market crashes associated with the two most severe economic crises of the last 15 years—the protracted Great Recession crisis (2008–2009) and the shorter but extreme COVID-19 pandemic crisis (2020). Juxtaposing the predominant expected utility theory perspective with observed deviations in investor behavior during crises, we find that both pre-crash firm-level customer satisfaction and customer loyalty are positively associated with abnormal stock returns and lower idiosyncratic risk during a market crash, while pre-crash firm-level customer complaint rate negatively affects abnormal stock returns and increases idiosyncratic risk. On average, we find that one standard deviation higher CCR is associated with between $0.9 billion and $2.4 billion in market capitalization on an annualized basis. Importantly, we find that these effects are weaker for firms with higher market share during the COVID-19 crash, but not during the Great Recession crash. These results are found to be robust to a variety of alternate model specifications, time periods, sub-samples, accounting for firm strategies during the crises, and endogeneity corrections. When compared to relevant non-crash periods, we also find that such effects are equally strong during the Great Recession crash and even stronger during the COVID-19 pandemic crash. Contributing to both the marketing-finance interface literature and the nascent literature on marketing during economic crises, implications from these findings are provided for researchers, marketing theory, and managers. Supplementary information The online version contains supplementary material available at 10.1007/s11747-023-00947-1.
| S-EPMC10225781 | biostudies-literature
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| S-EPMC1315680 | biostudies-literature
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| S-EPMC2871235 | biostudies-literature
Project description:Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one's own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure.
| S-EPMC5430984 | biostudies-literature
Project description:OBJECTIVES:Approximately one in eight practices in primary care in England are 'dispensing practices' with an in-house dispensary providing medication directly to patients. These practices can generate additional income by negotiating lower prices on higher cost drugs, while being reimbursed at a standard rate. They, therefore, have a potential financial conflict of interest around prescribing choices. We aimed to determine whether dispensing practices are more likely to prescribe high-cost options for four commonly prescribed classes of drug where there is no evidence of superiority for high-cost options. DESIGN:A list was generated of drugs with high acquisition costs that were no more clinically effective than those with the lowest acquisition costs, for all four classes of drug examined. Data were obtained prescribing of statins, proton pump inhibitors (PPIs), angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEis). Logistic regression was used to calculate ORs for prescribing high-cost options in dispensing practices, adjusting for Index of Multiple Deprivation score, practice list size and the number of doctors at each practice. SETTING:English primary care. PARTICIPANTS:All general practices in England. MAIN OUTCOME MEASURES:Mean cost per dose was calculated separately for dispensing and non-dispensing practices. Dispensing practices can vary in the number of patients they dispense to; we, therefore, additionally compared practices with no dispensing patients, low, medium and high proportions of dispensing patients. Total cost savings were modelled by applying the mean cost per dose from non-dispensing practices to the number of doses prescribed in dispensing practices. RESULTS:Dispensing practices were more likely to prescribe high-cost drugs across all classes: statins adjusted OR 1.51 (95% CI 1.49 to 1.53, p<0.0001), PPIs OR 1.11 (95% CI 1.09 to 1.13, p<0.0001), ACEi OR 2.58 (95% CI 2.46 to 2.70, p<0.0001), ARB OR 5.11 (95% CI 5.02 to 5.20, p<0.0001). Mean cost per dose in pence was higher in dispensing practices (statins 7.44 vs 6.27, PPIs 5.57 vs 5.46, ACEi 4.30 vs 4.24, ARB 11.09 vs 8.19). For all drug classes, the more dispensing patients a practice had, the more likely it was to issue a prescription for a high-cost option. Total cost savings in England available from all four classes are £628 875 per month or £7 546 502 per year. CONCLUSIONS:Doctors in dispensing practices are more likely to prescribe higher cost drugs. This is the largest study ever conducted on dispensing practices, and the first contemporary research suggesting some UK doctors respond to a financial conflict of interest in treatment decisions. The reimbursement system for dispensing practices may generate unintended consequences. Robust routine audit of practices prescribing higher volumes of unnecessarily expensive drugs may help reduce costs.
| S-EPMC6377511 | biostudies-literature
Project description:AimsPrescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings.MethodsA systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data.ResultsA prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed.ConclusionsThis prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future.
| S-EPMC4693490 | biostudies-literature